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GPs buried under trusts' workload dump

RCGP does not support BMA plans for 'safe' limits on GP appointments

The RCGP has distanced itself from the BMA's suggestion that GPs should cap their daily patient consultations at a 'safe' limit, but has said that GPs need an emergency brake to alleviate pressures.

It comes as NHS England has clarified that 'arbitrary caps on patient appointments' would be an automatic breach of the GP contract.

The BMA's new guidance on GP 'black alerts', unveiled earlier this week, suggested a limit per GP of 25-35 routine consultations - or 15 complex consultations - as a recommended 'safe' limit before agreeing with CCGs to send patients on to 'overspill' clinics.

The BMA, which voted in favour of GP practice black alerts last year, has established four 'operational pressures escalation levels' similar to the system used in hospitals.

The RCGP told Pulse it supports the idea of GP black alerts but not the proposed cap on daily consultations.

A spokesperson said this was 'given how varied and diverse GP consultations can be'. 

'For example, 40 simple, single-issue consultations could be akin to 10 consultations with complex patients,' they said.

RCGP chair Professor Helen Stokes-Lampard said: 'We agree with our colleagues at the BMA that GPs need to be able to raise some sort of warning signal when things become too much – this is something that the College has been advocating for some time.'

She said this comes as 'members tell us that they are routinely working 11-hour intensive days in clinic, and then having to deal with a mountain of urgent paperwork on top'.

She said: 'This isn’t safe, for the GP or their patients... A "black alert" would be a lifeline for practice teams that are overwhelmed by demand, and allow for practices to implement emergency measures to alleviate pressures.'

Meanwhile, asked whether the plans had been approved by NHS England, BMA GP committee chair Dr Richard Vautrey suggested this was not required.

He told Pulse that this meant 'working within the existing contractual mechanisms to be able to deliver a safe and sustainable service'.

He said: 'It's in everybody's interest whether that's the local CCG, NHS England or general practice, to have a sustainable safe service. We would hope that local commissioners will work with practices to enable that to happen.'

'No right-minded thinking person would want their patients to be seen by tired, exhausted doctors.'

However an NHS England spokesperson said: 'While arbitrary caps on patient appointments would breach GPs’ contracts, we understand the pressures general practice is facing.

'That’s why the NHS is investing £2.4 bn extra in GP services, growing the number of new doctors entering general practice, and rolling out evening and weekend appointments to patients across England over this coming year.'


Readers' comments (48)

  • Maverick

    If I could have my time again, I would choose to be an architect and not a doctor. To create something beautiful, functional and useful. Medicine today is for ovine masochists.... particularly general practice. Fortunately for me, I do have my time again. I am no longer a doctor. I left GP land in the summer of 2016, aged 55. I am building my life from the ground up. So exciting... so rewarding..and so can you! To all of the contributers to this publication who are unhappy with their lot (as principals, partners, salaried and locums) I would say... take a long hard look at your life and make a selfish choice for yourself, your family and your friends. Like minded collegues read your comments and empathise but that's it... nothing happens. No-one cares. Leave the toxic broken NHS. Emigrate if you must. Protesting is futile. Vote with your feet.
    If you are happy with the path Hunt and his bunch of nutters have planned for you, then stay and enjoy the ride. Good luck to you all. The GMC is here to stay. The BMA is here to stay. Not so sure about the RCGP..... when there are no GPs left ... can you have a Royal College of ... nobody..? GPFV CCGs and CQC will mutate into LHAs RHAs PCTs and so-on ad infinitum.
    Don't wait around for this government to fix the NHS as a centrally funded public service. It's not on their agenda. Time to think for yourselves...

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  • Dear All,
    So arbitrary targets for other parts of the NHS, 4 hrs in A/E, 2 week rules etc are OK?
    Just part and parcel of supporting and invigorating General Practice.
    Hey ho.
    Paul C

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  • Be careful what you wish for.

    New regulation from NHSE:
    Each doctor must not spend more then 8 hours/day
    However, there must be minimum of 90 F2F appointments/1000 patient
    No uplift in GMS/PMS contract value.

    Result? Partners will go bankrupt as we need to suddenly fund twice the number of clinicians at same funding (i.e. 1/2 our income)

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  • RCGP.
    What are you good for?
    Absolutely nothing.
    Say it again.

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  • Copernicus’ post above is being tabled as a strategy guide to control those pesky GPs by NHSE members as we speak...

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  • Hence I have stopped my RCGP subscription and continued with the BMA.RCGP should ask the government to fund them

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  • I wonder why RCGP is called RCGP. It is supposed to be representing us GP. I can't see any sign of that. let them call themselves Royal college of politician or RC of national health or Royal college of public. Let everybody stop paying RCGP membership. RCGP accreditation is not mandatory for practicing general practice.

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  • Maverick at 10:54pm - too true.

    I did the same and my sanity soared. I've been in the commercial world for almost 20 years and none of the jobs has approached the stress and no-win predicament that is general practice.

    It's a tough thing to do - to dig that tunnel out of the gulag. But well worth it.

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  • So the contract is unsafe. I limit 30 patients and 2 visits and this is bloody hard work. I used to do more and it was totally unsafe.
    Only way to have any control is to not be subject to the contract ie not a partner or have a long wait for appointments.

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